Health, Education and General Practice

Teeling Smith, G. ed.

January 1986

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This booklet is based on a meeting organised by the Office of Health Economics and chaired by Sir John Butterfield at the Ciba Foundation on 30th October 1985. The meeting was a follow-up to a similar more general OHE discussion held at Cumberland Lodge in June 1984, whose proceedings were published under the title 'A New NHS Act for 1996?'

The present booklet contains the nine prepared papers on which the 1985 discussion was based, together with a shorter contribution from the Chief Medical Officer at the

Department of Health and Social Security which he presented at the meeting. The final chapter is a summary of some of the main points raised in the discussion. There is a foreword by Sir John.

These proceedings cannot pretend to offer a definitive account of the best way in which general practice should develop under the National Health Service in the years ahead. However, it does provide an optimistic view of the potential for general practice and some 'signposts' as to how general practitioners and their team can best help to promote the good health of the population.

The booklet points out there are many different ways in which individual general practices are organised, and it expresses regret that more has not been done to evaluate the effect of those differences. There is no crisis in general practice but this does not mean that no improvements are possible. The steady advances in organisation and performance which have taken place over the past twenty years can be expected to continue largely as a result of internal pressures, and in response to realistic expectations from better informed patients. These advances will continue to take many different forms; the pathway forwards in general practice is a broad avenue rather than a narrow gangplank.

Incidentally, the conclusions from the 1985 meeting form a sharp contrast to those from an earlier meeting organised by the Office of Health Economics in 1963. This was held at Magdalen College, Oxford and was entitled 'Incentives in General Practice'. The record of that meeting (which was unpublished) referred to the 'present criticism and dissatisfaction amongst general practitioners'. The opinion was expressed in 1963 that 'it would be wrong to expect an "operation bootstrap" to raise the standards within the profession itself'. The response was, of course, the 'New Charter' for general practice a few years later, from which much of the subsequent improvement has flowed.

There are still isolated pockets of poor practice, and various ways were discussed at the 1985 meeting to deal with this problem. But these isolated instances must not be allowed to detract from the overall positive and optimistic picture which emerges for the development of general practice in Britain in the 1980s and 1990s.